{"id":6649,"date":"2018-03-26T17:17:03","date_gmt":"2018-03-26T17:17:03","guid":{"rendered":"http:\/\/hnetalk.com\/member\/?p=6649"},"modified":"2018-03-26T17:18:08","modified_gmt":"2018-03-26T17:18:08","slug":"national-coverage-determinations-3","status":"publish","type":"post","link":"https:\/\/hnetalk.com\/member\/national-coverage-determinations-3\/","title":{"rendered":"National Coverage Determinations*"},"content":{"rendered":"

Health New England Medicare Advantage makes mid-year benefit changes only\u00a0when Medicare changes its coverage rules. As a Medicare health plan, our Medicare\u00a0Advantage must cover all services covered by Original Medicare.<\/p>\n

When Medicare changes its coverage rules, Medicare issues a National Coverage Determination\u00a0(NCD) explaining whether Medicare will pay for an item or service. The list below contains all recent\u00a0changes from the past year to Health New England\u2019s Medicare Advantage health care benefits:<\/p>\n

\u2022\u00a0Leadless Pacemakers<\/strong>
\nEffective January 18, 2017, the Centers for Medicare & Medicaid Services (CMS) covers\u00a0leadless pacemakers through Coverage with Evidence Development (CED). CMS covers\u00a0leadless pacemakers when procedures are performed in Food and Drug Administration (FDA)\u00a0approved studies. CMS also\u00a0 \u00a0 \u00a0 \u00a0covers, in prospective longitudinal studies, leadless pacemakers\u00a0that are used in accordance with the FDA approved label for devices that have either an\u00a0associated ongoing FDA approved post-approval study or completed an FDA post-approval study.<\/p>\n

\u2022 Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease<\/strong>
\nEffective May 25, 2017, the Centers for Medicare & Medicaid Services (CMS) has determined\u00a0that the evidence is sufficient to cover supervised exercise therapy (SET) for beneficiaries with\u00a0intermittent claudication (IC) for the treatment of symptomatic peripheral artery disease\u00a0(PAD). Up to 36 sessions\u00a0 over a 12-week period are covered if all of the components of a SET\u00a0program are met.<\/p>\n

All NCDs are effective on the date the decision memorandum is released. The date it is\u00a0posted to the National Coverage Analysis page of the Medicare Coverage Center website\u00a0at cms.gov\/medicare-coverage-database<\/a>.<\/p>\n

If the newly covered service is covered outside of the contract, the covered service may be\u00a0obtained from any Medicare provider, including out-of-network providers.<\/p>\n

To request printed copies or if you have any questions, please call Member Services at (413) 787-0010\u00a0or toll-free at (877) 443-3314 (TTY: 711). Member Services hours are 8 a.m. – 8 p.m., Monday – Friday\u00a0(Oct. 1 – Feb. 14: 8 a.m. – 8 p.m., seven days a week).<\/p>\n

*Health New England Medicare Advantage is an HMO Plan with a Medicare contract. Enrollment in\u00a0Health New England Medicare Advantage depends on contract renewal. This information is not a\u00a0complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and\/or copayments\/coinsurance may change on January 1\u00a0of each year.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Health New England Medicare Advantage makes mid-year benefit changes only\u00a0when Medicare changes its coverage rules. As a Medicare health plan, our Medicare\u00a0Advantage must cover all services covered by Original Medicare. When Medicare changes its coverage rules, Medicare issues a National Coverage Determination\u00a0(NCD) explaining whether Medicare will pay for an item or service. The list below […]<\/p>\n","protected":false},"author":11,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[17],"tags":[],"class_list":["post-6649","post","type-post","status-publish","format-standard","hentry","category-medicare"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZGa-1Jf","_links":{"self":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/6649","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/comments?post=6649"}],"version-history":[{"count":2,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/6649\/revisions"}],"predecessor-version":[{"id":6652,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/6649\/revisions\/6652"}],"wp:attachment":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/media?parent=6649"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/categories?post=6649"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/tags?post=6649"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}